title: BD ProEx C immunostaining in extramammary Paget's disease and perineal melanoma.
abstract: The differential diagnosis of perineal biopsies can include squamous intraepithelial lesions, extramammary Paget's disease, and melanoma. Less frequently two of these lesions coexist. BD ProEx C is a recently developed immunoassay that targets expression of two genes shown to be associated with cervical cancer. Immunostaining for ProEx C has been validated in cervical cytology and positive staining has also been shown to be strongly associated with human papilloma virus (HPV)-induced cervical and anal intraepithelial neoplasia in biopsies. We observed positive staining for ProEx C in Paget cells in all of 26 cases of Paget's disease irrespective of tissue site (extramammary, mammary) and in melanoma cells in all of 12 cases of primary perineal melanoma with immunostaining in >50% of malignant cells in 73% of Paget disease cases and 43% of perineal melanoma cases. Positive staining was heterogeneous and exclusively nuclear in all cases. In situ hybridization was negative for low-risk and high-risk HPV subtypes in all Paget and melanoma cases that were tested. Currently neither of these lesions is known to be HPV related although according to the literature the possibility of a role for HPV in melanoma is still unsettled. Relevant literature is reviewed.
authors.affiliation: Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. walts@cshs.org
authors.forename: Ann E
authors.initials: AE
authors.lastname: Walts
authors.forename: Shikha
authors.initials: S
authors.lastname: Bose
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification; D000951:Antigens, Neoplasm / Q000032:analysis*; D001005:Anus Neoplasms / Q000201:enzymology* / Q000473:pathology / Q000821:virology; D001706:Biopsy; D018797:Cell Cycle Proteins / Q000032:analysis*; D004250:DNA Topoisomerases, Type II / Q000032:analysis*; D004279:DNA, Viral / Q000302:isolation & purification; D004268:DNA-Binding Proteins / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007118:Immunoassay; D017403:In Situ Hybridization; D008297:Male; D008545:Melanoma / Q000201:enzymology* / Q000473:pathology; D008875:Middle Aged; D064111:Minichromosome Maintenance Complex Component 2; D009092:Mucous Membrane / Q000201:enzymology / Q000473:pathology / Q000821:virology; D009687:Nuclear Proteins / Q000032:analysis*; D010145:Paget Disease, Extramammary / Q000201:enzymology* / Q000473:pathology / Q000821:virology; D010502:Perineum / Q000473:pathology* / Q000821:virology; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic; D014625:Vaginal Neoplasms / Q000201:enzymology* / Q000473:pathology / Q000821:virology; D014846:Vulvar Neoplasms / Q000201:enzymology* / Q000473:pathology / Q000821:virology
chemical_list: D000951:Antigens, Neoplasm; D018797:Cell Cycle Proteins; D004279:DNA, Viral; D004268:DNA-Binding Proteins; D009687:Nuclear Proteins; D011933:Reagent Kits, Diagnostic; C084859:MCM2 protein, human; D064111:Minichromosome Maintenance Complex Component 2; D004250:DNA Topoisomerases, Type II